Healthcare Provider Details

I. General information

NPI: 1063604957
Provider Name (Legal Business Name): IRENE SPIEKER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENA SPIEKER

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 LAKE OTIS PKWY SUITE #204B WOMENS HEALTHCARE CENTER
ANCHORAGE AK
99504
US

IV. Provider business mailing address

4050 LAKE OTIS PKWY SUITE #204B WOMENS HEALTHCARE CENTER
ANCHORAGE AK
99504
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-9586
  • Fax: 907-929-3836
Mailing address:
  • Phone: 907-929-9586
  • Fax: 907-929-3836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberANP0136
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: